North Carolina's Novant Health files suit against Aetna in contract dispute

Not-for-profit healthcare system Novant Health Inc. in Winston-Salem, N.C., doesn't think that Aetna Inc. has played fair in contract negotiations. Novant has filed a lawsuit in Mecklenburg Superior Court against the Hartford, Conn.-based health insurer alleging that Aetna misused confidential financial data and falsely told doctors, patients and the media that Novant's inpatient and outpatient costs are higher than state and national averages. "They've done some long-lasting damage to our organization," Kati Everett, Novant spokeswoman, tells the Charlotte Business Journal.

Novant accuses Aetna of trying to obtain leverage in negotiations because their two-year contract is set to expire on July 1. In May, Aetna officials told local media outlets that Novant charged 18 percent higher than the state average and 23 percent higher than the national average for inpatient services, as well as 28 percent and 36 percent higher than state and national averages, respectively, for outpatient services, reports the Charlotte Observer. In addition, Aetna sent approximately 3,000 letters to Novant-affiliated healthcare professionals telling them that Novant was seeking a 13.5 percent fee increase for its Charlotte-area hospitals in addition to the increase of almost 8 percent that these hospitals received earlier this year.

Aetna expressed disappointment that Novant went the litigation route. The current contract "specifically authorizes Aetna to communicate with our constituents, such as customers, members and physicians," says company spokesman Cynthia Michener. None of the information revealed by Aetna "constitutes proprietary information," she states.

Despite the lawsuit, both sides indicated a willingness to get a deal done by June 30. However, the lawsuit isn't a negotiating ploy, Jim Tobalski, a senior vice president for Novant, tells the Winston-Salem Journal. "We filed this lawsuit to hold Aetna accountable for publicly deceiving patients and employers and misrepresenting facts in order to disrupt people's relationship with their physician and hospital. We know our prices are not higher."

To learn more:
- read this Charlotte Business Journal article
- read this Charlotte Observer article
- take a look at this Winston-Salem Journal article